Reassessment of American Joint Committee on Cancer Staging for Stage III Renal Cell Carcinoma With Nodal Involvement: Propensity Score Matched Analyses of a Large Population-Based Study.

Jianglong Han,Qibin Song,Yunfeng Qiao,Zhenming Fu,Rui Zhang,Qin Li,Shijie Wang,Ping Li

doi:10.3389/fonc.2020.00365

Jianglong Han, Qibin Song + Show 6 more

Open Access

https://doi.org/10.3389/fonc.2020.00365

Copy DOI

Abstract

Background: To assess the role of nodal involvement in stage III renal cell carcinoma (RCC) according to the American Joint Committee on Cancer (AJCC) 8th staging system. We compared the survival outcomes of RCC patients with pT1−3N1M0 disease and those with pT3N0M0 or stage IV (stratified as pT4NanyM0 and pTanyNanyM1) disease in a large population-based cohort.Methods: A cohort of 3,112 eligible patients with RCC was identified from the Surveillance, Epidemiology, and End Results (SEER) database, registered between January 2004 and December 2015. Kaplan-Meier and Cox proportional hazards models were used to evaluate the overall survival (OS), and cancer-specific survival (CSS). The prognostic value of the modified stage for pT1−3N1M0 disease was assessed by nomogram-based analyses. Propensity score matching (PSM) was used to adjust for potential baseline confounding.Results: Patients with pT1−3N1M0 disease showed similar survival outcomes (median OS 41.0 vs. 38.0 months, P = 0.77; CSS 45.0 vs. 39.0 months, P = 0.59) to pT4NanyM0 patients, whereas the significantly better survival outcome was found for pT3N0M0 patients. After PSM, comparable survival rates were observed between pT1−3N1M0 group and pT4NanyM0 group, which were still significantly worse than the survival of pT3N0M0 patients. The modified stage IIIA (pT3N0M0), IIIB (pT1−3N1M0, pT4NanyM0), and IV (pTanyNanyM1) showed higher predictive accuracy than AJCC stage system in the nomogram-based analyses (concordance index: 0.70 vs. 0.68, P < 0.001 for OS; 0.71 vs. 0.69, P < 0.001 for CSS).Conclusions: The pT1−3N1M0 RCC might be reclassified as stage IIIB together with pT4NanyM0 disease for better prediction of prognosis, further examination and validation are warranted.

Highlights

Renal cell carcinoma (RCC) ranks the third most common genitourinary malignancy in men and fourth among women, with an estimated 403,262 new cases and 175,098 deaths worldwide [1]
The pT1−3N1M0 RCC might be reclassified as stage IIIB together with pT4NanyM0 disease for better prediction of prognosis, further examination and validation are warranted
Even though the determinant prognostic role of Lymph node (LN) involvement might exist in the survival of RCC patients, the current 8th version of the American Joint Committee on Cancer (AJCC) staging manual classifies both the pT1−3N1M0 disease and pT3N0M0 disease as stage III disease [8]

Summary

Introduction

Renal cell carcinoma (RCC) ranks the third most common genitourinary malignancy in men and fourth among women, with an estimated 403,262 new cases and 175,098 deaths worldwide [1]. Even though the determinant prognostic role of LN involvement might exist in the survival of RCC patients, the current 8th version of the American Joint Committee on Cancer (AJCC) staging manual classifies both the pT1−3N1M0 disease and pT3N0M0 disease as stage III disease [8]. The recent MD Anderson Cancer Center (MDACC) study reported that RCC patients with pT1−3N1M0 disease by the AJCC 8th staging should be reclassified as having stage IV disease [12]. Another large cohort from China suggested that T1−3N1M0 disease should be reclassified to be combined with T4N0M0 rather than T3N0M0 disease [13]. We compared the survival outcomes of RCC patients with pT1−3N1M0 disease and those with pT3N0M0 or stage IV (stratified as pT4NanyM0 and pTanyNanyM1) disease in a large population-based cohort

Methods

Results

Conclusion